Tube: a hollow elongated cylinder: especially one to convey fluids. People are tubes. This is about the human gut and what passes through it.

Twenty-five years ago I was diagnosed with a supposedly incurable condition known as ulcerative colitis. About five out of every thousand people have it. The disease causes inflammation and ulceration of the large intestine, resulting in bouts of severe bloody diarrhea. Left untreated, UC can be extremely debilitating. But even the best treatments often fail, leaving no choice for victims other than surgical removal of all or part of the big gut and the unglamorous prospect of a colostomy bag.

Until recently for the better part of those twenty-five years I’ve been in remission, with relatively minor digestive complains and no flare-ups. All that changed, or seemed to, not long ago after a routine colonoscopy, at a follow-up visit with a nurse practitioner (the doctor who’d done the exam was on vacation). She told me my disease was not only as chronic as ever, but—despite few symptoms—active. What I’d chalked up to bad digestion was the resurgence of an incurable and potentially devastating disease.

The nurse practitioner’s verdict left me distressed and depressed, contemplating a return to the regimen of draconian (and mostly useless) diets and drugs whose side effects were as considerable as their efficacy, and that offered only some relief, but no cure.

So I did what many do these days when confronted with a nasty diagnosis: I went online. For two nights running, I stayed up searching for the latest treatments for ulcerative colitis. Since my last flare-ups, a couple of new drugs had come on the market, each with a laundry list of dastardly side effects, none offering more than the possibility of remission.

Then, after hours of nocturnal research, I came across something that not only caught my eye, but that made me wonder if I’d fallen asleep and was dreaming, something so bizarre, so outrageous, it would have been right at home with the most transgressive works of surrealist cinema and literature, with Bunuel’s Un Chien Andalou and Bataille’s “Story of the Eye.” A procedure known as an FMT—a “Fecal Microbiota Transplantation.” A shit transplant.

Treating diseases with fecal matter isn’t new. It dates all the way back to the 4th century, when, according to Chinese medicine doctor Ge Hong, patients were fed a yellowish broth (“yellow soup”) of fecal matter to cure them of food poisoning and severe diarrhea. Among the many “cures” for the Black Death was one that called for lancing the buboes of the afflicted and applying to them a poultice of tree resin, roots of white lilies, and dried human shit. In the early days of steam-powered vessels, when boilers and pipes exploded routinely, human shit was used as a salve and applied to the burns of Irish trawler crews.

Shit transplants, on the other hand, are a recent innovation. Just over fifty years ago, in 1958, Dr. Ben Eiseman of the University of Colorado published a report in which he described having cured four patients of their life-threatening intestinal disorders using enema solutions of donated “healthy” feces. Since then, similar procedures have resulted not only in complete remissions, but in actual cures for people suffering from supposedly “incurable” bowel disorders, in particular Clostridium or C. difficile, a disease attributed to the destruction of necessary intestinal flora resulting from overuse of antibiotics. The procedure has also been used to treat those suffering from other autoimmune diseases, including asthma and rheumatoid arthritis. The treatment bears quick, if not instantaneous, results, costs little, can be done on an outpatient basis, and poses minimal risks.

All this I learned propped up in my bed long after midnight, my iPad glowing in the dark. Imagine, I thought, walking into a doctor’s office with a nasty “incurable” disease, only to walk out a few hours later with someone else’s shit inside you, cured. It seemed too good to be true.

Sure enough, there was a catch. I continued investigating, trying to find out where in my part of the world Fecal Microbiota Transplantations were being offered, plugging different terms into Google’s search engine, only to realize that it wasn’t being offered anywhere in the United States, that I’d have to go to Australia and England, and even then I’d have to add my name to long waiting lists. In my own country, with few exceptions—and those limited to medical trials exclusively for those suffering from C. difficile—no one was offering the treatment.

Blame the FDA, the United States Food and Drug Administration. In its infinite wisdom, under the undoubted influence of pharmaceutical corporations and their lobbyists, the FDA declared human shit a drug and subjected it to the same draconian regulations as apply to all experimental medicines, enforcing the need for complex and expensive clinical studies such as only pharmaceutical companies can afford, making it next to impossible for willing doctors to provide the therapy. I sat there, in the darkness of my bedroom, my raised hopes dashed.

All wasn’t lost, though. Though the FDA has the power to declare shit a drug, it can’t otherwise regulate that which the healthy human body produces in substantial quantities, and on a regular basis. As far as the average consumer is concerned, supply side economics still hold. As long as we’re not doctors treating patients with it, shit is free and available to any of us who want it.

Thanks to this, something like a cottage industry in do-it-yourself fecal transplants has sprung up. There’s even a website dedicated to it: The Power of Poop: promoting safe, accessible fecal microbiota transplant for all who need it. From there my online searching led me to a half-dozen YouTube videos, each providing detailed instructions as well as lists of equipment: a plastic Tupperware (or some other airtight container) for collection of the “donor stool,” a large measuring cup, a disposable enema (emptied), a kitchen strainer, sea salt, distilled water, a sacrificial towel, a spoon, rubber gloves (for the squeamish), and a dedicated food processor or blender.

Watching the videos, seeing the evangelistic zeal with which their producers embraced the therapy’s virtues, I got the feeling some of them would keep at it long after their diseases were cured. Joking aside, they seemed to be well-meaning people, people, people with bad intestines but good intentions.

Four a.m. My iPad’s battery was just about drained. I lay there, a set of wind chimes tintinnabulating beyond my bedroom window, daydreaming of disposable enemas replete with fecal milkshakes, and of my own rosy guts basking in the salubrious glow of eschericia coli, candida albicans, ruminococcus calidas, and swarms of other beneficial flora.

But there was another catch. Though billed as a “do-it-yourself” undertaking, a home administered FMT requires another willing participant: the donor. Said donor must, it goes without saying, be free of diseases and infections. He or she should also have a normal, healthy digestive system, one capable of producing an ideal “donor stool.”

In case you happen to wonder just what that is, there’s the Bristol Stool Chart, the brainchild of a Dr. Ken Heaton of the University of Bristol. The chart features seven different stool classifications, from Type #1 (“separate, nut-like hard lumps; hard to pass”) through Type #7 (“completely liquid, no solid pieces”), each accompanied by a colored illustration, with the Ideal Type (#4, “like a sausage or snake, smooth and soft”) halfway down. Though not required, the ideal contributor of this el supremo stool would be a close member of the patient’s immediate family, the better to insure compatibility.

For me the choice for a donor was obvious. All these years my twin brother George has taken my shit; it seemed only fair that for a change I should take some of his. The difference was I’d have to ask his permission.

How would I go about doing so? What would I say? Hey, George, I need some shit, can I have some of yours? I’d have to go about it much more discretely, to work up to it incrementally, through a series of inconspicuous inquiries. “I see you’ve been re-reading Spinoza lately,” or “What sort of soil augmentation do you recommend for planting hydrangeas?” “Say, did you grout those bathroom tiles yourself?” Something to get the conversational ball rolling, so to speak. Eventually we’d get to the matter at hand. It seemed simple enough.

But it wasn’t simple. Over the years I’d asked my twin for all kinds of things. Still, I couldn’t imagine asking him for that. Why was it such a big deal? It’s not like I’d be asking him for a leg or part of his liver. Hell, it wouldn’t cost him a thing. And he’d be saving my life—well, he’d save it from all kinds of misery, anyway. So what was the problem? What’s not to like?

Witness the extremes to which men have gone to dispose of or dispense with this part of their existence, the elaborate sewage systems of Paris and London, the latter with 37,000 miles of drains, culverts, tunnels, and aqueducts in a catchment extending from the center of the city eighty miles to the town of Swindon in South West England. “Good riddance to bad rubbish” sums-up Western attitudes toward shit.

Westerners aren’t alone. Among Islamic peoples the left hand, reserved for bodily hygiene and therefore unclean, is never used for eating; to shake hands or give someone something using it is an insult suited for infidels. Among Hindus in India’s ancient caste system the handling of human waste was considered taboo and assigned to “sweeper” communities of Untouchables. So determined are we to disassociate ourselves from our own excreta we can’t even bring ourselves to even utter its name: shit, a word of noble pedigree whose use as both a noun and verb goes back to the 14th century, and whose roots can be traced to the Old English scite, and Middle Low German schite, meaning “dung,” also to the Old English scitte (“diarrhea”), and from there to the Dutch schijten, the Swedish skita, and the Danish skide, each extending from the Indo-European skheid, meaning “split, divide, or separate,” making shit a cousin to schist and schism, while linking it to the Ancient Greek skor—the genitive of skatos, meaning “to cut off,” and from whence we get “scatology.”

Given its history, it may surprise some to learn that in its formative years the word “shit” had no vulgar or negative associations; those came later. It was a simple harmless verb meaning “to defecate,” or a noun for that which was defecated. Over centuries it took on its other meanings and connotations, including as a vague noun standing for just about anything (I’m not taking any more shit from her; You need to get your shit together) and a vaguer expletive of surprise (No shit?) or shock (Shit!). Shit stands for trouble, as in We’re in deep shit and The shit’s gonna hit the fan, also for displeasure (That was a shitty meal; what a piece of shit), but it can also express approval or dominance (X is the shit, man!). Still, by and large its use is pejorative, as in You’re full of shit—which, though literally true, still isn’t meant as a compliment. Nor do the expressions shithead, shitheel, shitface, shitdick, shitbreath, chickenshit, or shit-for-brains qualify as terms of endearment.

I remember the very first time I heard a grown-up other than my father use the word. His name was Art, and he was a machinist my inventor papa hired to turn metal parts for him in his ratty laboratory at the bottom of the driveway of the house where I grew up. While operating the lathe, between slugs from a pint bottle of Rock and Rye, Art, whose face was always ruddy and shadowed with razor stubble and who had an overall gruff manner, used to sing a little ditty. It went:

Took my gal to the baseball game Sat her up in front Along came a fly ball And socked her in the — Country boy, country boy Sitting on a rock, Along came a bee And stung him in the — Cocktail ginger ale

five cents a glass If you don’t like it, Shove it up your — Ask me no more questions, I’ll tell you no more lies A man got hit with a bag of shit Right between the eyes.

I was seven years old, and the ditty, or anyway hearing Art say “shit,” made a deep impression on me, as if the word itself had flown in through the window of my father’s laboratory and struck me between the eyes. My father was an avowed atheist; except once or twice to admire the stained glass windows my brother and I had never set foot inside a church. Compared to most of my churchgoing friends the conditions of my upbringing were anarchic; my twin brother and I knew relatively few boundaries, and nothing was sacred. Still, when Art pronounced that word, suddenly this child of an atheist grasped the concept of profanity no less than if he’d witnessed the sacking of the Somnath temple by Mahmud of Ghanzi.

Years later, playing scrabble or Gin rummy in the sunroom of his Wading River, Long Island, home, my fiancée’s father—a survivor of the “bloody” Rapido River and Monte Cassino—wouldn’t tolerate the words “shit” or “crap” spoken in his presence. You could say “Damn!” or “Screw it!” or “Christ!” and even “Son of a bitch!” and an occasional “Fuck!,” but “shit” and “crap” were off-limits.

One day I dared to ask him why.

“Because—they’re dirty,” was all Mr. Loughlin would say.

To avoid uttering the word “shit,” people have gone to extremes almost as far as London’s sewers, resorting to euphemisms from the clinical (“feces,” “defecate”) to the bureaucratic (“human waste,” “excretory product”) to the poetic (“night soil”) to the colorfully sacrilegious (“play chess with the Pope”) to the downright racist (“dropping the Cosby kids off at the pool”). So great is the cultivated aversion to shit, even the places of excretion must be kept hidden behind a veil of euphemisms, with the too-indiscreet “toilet” giving way to “lavatory,” “bathroom,” “powder (or ‘rest’ or ‘wash’) room,” “water closet,” and the even more covert “w. c.” In Whose Afraid of Virginia Woolf?, Edward Albee’s Pulitzer Prize-winning play, responding to another character’s request, embattled husband George says to Martha, his wife, “Martha, will you show [our guest] where we keep the, uh, euphemism?”— this in a drama whose otherwise scathing frankness scandalized viewers in 1966.

Given the current status of toilets and shit, it’s hard to believe there was once a time when to attend a monarch sitting on his commode was considered an honor. But just as the word shit’s profane implications developed over time, the taboo against the substance itself is a relatively recent development. As Erasmus notes in his 1530 conduct manual, the De civilitate morum puerilium (OnGood Manners for Boys):

But is it also true that men are offended not so much by excrement itself as by the current view of it; to the earliest mortals this substance was not so disgusting as it is to us, for they called it by the very auspicious name of laetamen [‘manure,’ from laetare, ‘to gladden’] and they had not hesitation in giving the god Saturn the nickname of ‘Sterculeus’ [from stercus, ‘dung, shit’], and this was a compliment if we believe Macrobius.

There was a time when people valued shit, when it was considered not only useful, but magical. As Theodor Rosebury notes in his Life of Man:

Feces renewed the life giving virtues of the earth; urine did a better job of cleaning than plain water¼ Today it is hard to reach back through our cultivated aversion and our affluence, when these materials have come to be the prime symbols of worthlessness, to a time when aversion had not been thought of and anything useful was necessarily treasured.

Shit hasn’t just been considered useful or magical; it’s even been held sacred. According to Susan Signe Morrison in her book Excrement in the Late Middle Ages, “The very filth marking degradation can be transformed into a sign of sanctity.” Among the greatest trials of Christina of Markyate—the twelfth-century recluse who, having taken a vow of chastity as a young girl, hid herself in the closet of a hermit monk’s cell to preserve her purity from a forced marriage—was her inability to defecate in that enclosed space. From Osbern Bokenham’s Book of Holy Women:

Through long fasting, [Christina]’s bowels became contracted and dried up¼ But what was more unbearable than all this was that she could not go out until the evening to satisfy the demands of nature. Even when she was in dire need, she could not open the door for herself, and Roger [the monk] usually did not come till late.

“Christine’s trial with excrement,” Morrison writes, “is made a glorious indication of her virtue and sanctity.” Through her pious withholding Christine “amend[ed] fecal matter into a sacred commodity.”

Notwithstanding which, by 1532—two years after Erasmus wrote his treatise for boys—the current suppression of things shitty by cultivated civilization was well-established. That was the year the censors at the College de la Sorbonne stigmatized Rabelais’ La vie de Gargantua et de Pantagruel as obscene owing to its scatological humor. But our aversion to shit isn’t purely founded on squeamishness and righteous indignation. There are practical considerations. Shit can be dangerous. It’s a potential carrier of all kinds of infections—bacterial, parasitical, viral and protozoal, including dysentery, typhoid, cholera, e. coli, to name only a handful. According to the World Health Organization, such waterborne diseases account for just over 4% of the total global burden of disease, and cause 1.8 million deaths annually. The lion’s share of those deaths can be traced to microorganisms found in human waste. Shit kills.

While we abhor our own shit, we’re also fascinated, and even obsessed, by it. Witness the use of human feces and other bodily fluids in works of modern and contemporary art, from Piero Manzoni’s 1961 masterpiece “Merda d’artista,” for which the Italian conceptual artist canned and sold ninety tins of his own shit for an amount equivalent to their weight in gold, to Noritoshi Hirakawa’s more recent “The Homecoming of Naval Strings,” an installation for the 2004 London Frieze Art Fair consisting of a live young woman defecating next to her chair each morning after reading a chapter of a novel by Philip Pullman. And not long ago I read somewhere that the curators of a San Francisco art gallery held an exhibition gathering artworks made of—or inspired by—human feces. The exhibit’s title was “I Poop You” and it was sponsored by a company of the same name, a “poop delivery service” that, for a modest fee, will ship an anonymous parcel of livestock dung to anyone you like—or don’t.

Poet Stanley Moss wrote an ode to shit:

… Out of the pain of this world

a kindness, a shape each of us

learns by heart: moon crescent,

jewelweed, forget-me-not,

hot lava. Christ, is this

the ghost of everything,

what I can and cannot,

I will and will not,

I have and have not,

what I must and must not,

what I did and did not?

If all that’s not proof enough of shit’s equivocal position in contemporary society, a few years back, at the Environmental Assessment Center in Okayama, Japan, in his quest for sustainable alternative sources of protein for human consumption a scientist named Ikeda came up with the ideal solution: a recycled form of protein-rich waste made from “sewage mud,” i.e., human shit. Ikeda’s process extracts proteins and lipids from the “mud.” The lipids are then mixed with a “reaction enhancer” and whipped by a device called an “exploder” into a substance with a texture not unlike ground beef, which, mixed with some soy sauce, makes a supposedly decent burger. According to Ikeda, at the time of the interview the cost of a “poop burger” was ten to twenty times more than its beef equivalent. Still, the substitute meat is not only low in fat, it helps reduce carbon emissions. Its inventor predicts that if their psychological aversion can be overcome, consumers will be more than willing to, as he put it, “complete the food chain.” It’s a sizeable “if.”

Useful or not, sacred or profane, taboo or not taboo, shit will always be with us, and not just with us, but on our minds and on the tips of our tongues.

“After her stroke,” essayist Donald Morrill writes,

¼ J’s mother is speechless. And of course it worries J and his father and sister, because his mother lives through talk, sometimes to their torment.

One evening at dinner, she burns her finger as she puts a plate down before her family.

“Shit!” she hisses, amazed at a term she has only used once or twice in public. Then she stands embarrassed and smiling.

Everyone is elated, and she says it again and again, slowly, and then again even more quickly, laughing, unable, though she tries, to utter any other term.

* * *

By now it was six in the morning. Through the cracks in my venetian blinds the sly beginnings of daylight peeped. So, I said to myself, I’d appeal to my brother; George. He’d take it in stride. He’d crack some bad jokes about being full of shit or the two of us getting our shit together. He’d slap my back, chuck my chin, and chalk it up to the liabilities of being my older (by two minutes) brother. “Think nothing of it, buddy,” he’d say. We’d seal the deal with Old Fashioneds or some other cocktail of George’s choosing, and never breathe a word of it to another living soul.

Unfortunately, that isn’t the George I know and love. Magnanimous in other ways, the George I know, the lover of good wines and fine dining, the curmudgeonly aesthete whose wrap-around-porched Queen Anne Victorian is so elaborately embellished even the wall stencils have stencils, would be disinclined to take part in an initiative that’s not only unquestionably unsanitary, but arguably dangerous and that reeks of quackery. And even if I could counter that last charge with published medical findings (including one in the New England Journal of Medicine), still, it wouldn’t do any good, since my brother, an economist and scholar for the better part of the last quarter century (as long as I’ve had my disease), knows as well as anyone that if you want to foist a ream of highly scented bullshit on a gullible readership, a scholarly journal is the place to do it.

No, I thought, lying there, the morning growing brighter through the slits in the venetian blinds, George will have no part of it. He flies around the world, invited by kings, sultans, emirs, and presidents to discuss their economies. He dresses in hand-tailored suits with Northamptonshire shoes and French-cuffed shirts of raw silk. Think of James Bond with a PhD in Economics instead of a License to Kill. He suffers fools poorly and eats cranks for breakfast. And though my brother’s no prude, an Edwardian streak about as wide as his porch runs through him. He’d no sooner take part in my or anyone else’s shit transplant than he’d shoot heroin or enter a hot dog eating contest or mud-wrestle. I could picture the look of disgust and contempt on his face—one identical to mine save for its squarer shape and finer nose: a look not unlike the look he—a free banker of the Austrian school—gets when confronted by Tea Party Objectivists or their bleeding-heart counterparts, his nose hairs crinkling to the stench of a truly shitty idea. “You want to what? With what? Have you lost your fucking mind?”

“Don’t be a fool,” I heard George say. “Listen to your doctor or doctors. And stop surfing the damn Web, speaking of fecal matter. The Internet is a reservoir, but it’s also a sewer. Anyone can drink from it, and anyone can pee—or shit, as the case may be—into it. Go home and take care of yourself, brother.”

No, my twin would have nothing to do with my fecal fantasies.

Or maybe he would. Yes, of course he would. He was my brother, after all; he loved me, he’d do whatever he had to, whatever was needed, to help me. But I could never bring myself to ask him.

Still, I couldn’t shake the image of my twin seated in the Moorish armchair of his Rococo study, wearing a plush robe and carpet slippers, smoking his Cavendish or Meerschaum pipe, listening to Dvorak or Satie, reading Carlyle or Gibbon, luxuriating in his cluttered Victorian splendor, as I, with an empty Tupperware vessel and a half-pleading, half-expectant look on my face, burst through the beaded curtain.

Seven a.m. Birds singing. I hadn’t slept a wink. I wondered: who else could I ask? My papa was dead; my mother too old. The rest of my relatives were safely across the Atlantic Ocean. As for close friends, one by one I considered and rejected them all. Too awkward, too embarrassing, too degrading. I’d rather have my gut yanked. I’d rather shit into a plastic pouch. I’d rather die.

In the end, there was no need to broach either my brother’s beaded curtain or his shit. My condition wasn’t as dire as I’d thought. Two weeks after that initial follow-up visit, I returned to the office of Dr. Heathcliff, the doctor who performed my colonoscopy, this time to meet with him in person. Reading from the same chart, he assured me that, however chronic, my ulcerative colitis was in no way “active.” The nurse practitioner who returned that damning verdict had misread the doctor’s scrawl.

I’m still in remission.

Yet I can’t say that I’m displeased by having undergone this upheaval. After all, it’s given me something to chew on—scratch that; some food for thought (scratch that as well). It’s made me think differently about something that, before, I either took for granted, ignored, or dismissed as disgusting.

No, I don’t think I’ll ever look on shit in quite the same way. From now on, before I dismiss or disparage or distance myself from it, before I flush it out of sight and mind down a series of dark hidden pipes, I’ll take a moment to reflect, to contemplate, to appreciate this unfairly condemned substance that, under different circumstances, might have saved my life. I’ll give it some consideration, some respect.

About Peter: I am the author of Drowning Lessons, winner of the 2007 Flannery O’Connor Award for Fiction, Life Goes to the Movies, a novel, two books on the craft of fiction, and two children’s books. My memoir, Confessions of a Left-Handed Man: An Artist’s Memoir, was short-listed for the William Saroyan International Prize for Writing. My latest novel, The Water Master, won the Pirate’s Alley William Faulkner Society Prize, and my essay, “The Kuhreihen Melody,” won the Missouri Review Jeffrey E. Smith Editors’ Prize. I teach at Antioch University’s low-residency MFA creative writing program and am Assistant Professor of Creative Writing at Georgia College & State University.

The Manifest-Station was created by Jennifer Pastiloff. Angela Patel is editor and full-time badass. These two beauty-hunters curate content that will move you, make you think, and remind you what it means to be human. Jen leads her workshops (The Manifestation Workshop: On Being Human) all over the world & online. Check the tab at the top under retreats/workshops. Jen is also the founder of "Girl Power: You Are Enough," to remind young women that yes, they do have a place in this world and they are enough. No matter what. Jen is represented by Adriann Ranta at Foundry Media. For queries please contact aranta@foundrymedia.com. And remember: Don't Be An Asshole. To contribute to our scholarship fund to help send a woman to a workshop/retreat please donate here:

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